REVIEW  VENOUS DISEASE Free access

International Angiology 2022 June;41(3):249-57

DOI: 10.23736/S0392-9590.22.04877-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Pharmacological treatment for chronic venous disease: an umbrella review of systematic reviews

Armando MANSILHA ¹, Sergio GIANESINI ^{2, 3}, Jorge H. ULLOA ⁴, Kirill LOBASTOV ⁵, Jinsong WANG ⁶, Andreas FREITAG ⁷, Kassandra R. SCHAIBLE ⁸ ✉, Monique MARTIN ⁷, Pelin YALTIRIK ⁹, Andrew N. NICOLAIDES ¹⁰

¹ Faculty of Medicine of University of Porto, Porto, Portugal; ² Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, Ferrara, Italy; ³ Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA; ⁴ Division of Vascular Surgery, Department of Surgery, University of the Andes, Bogota, Colombia; ⁵ Pirogov Russian National Research Medical University, Moscow, Russia; ⁶ Affiliated Hospital Sun Yat-Sen University, Guangzhou, China; ⁷ Evidera, London, UK; ⁸ Evidera, Waltham, MA, USA; ⁹ Internal Medicine and Neuropsychiatry, Global Medical and Patient Affairs (GMPA), Servier, Suresnes, France; ¹⁰ Medical School, Department of Surgery, University of Nicosia, Nicosia, Cyprus

INTRODUCTION: Chronic venous disease is a persistent venous drainage alteration caused by valvular incompetence and/or outflow obstruction. Disease management includes a variety of treatments, whose evidence and clinical performance in the mid-long term are variable. The objective of this umbrella review was to summarize efficacy data for pharmacological treatments including venoactive drugs from previously published reviews that included a meta-analytic component.
EVIDENCE ACQUISITION: Systematic database searches were conducted via Ovid SP on 13 August 2019, covering MEDLINE, Embase, and the Cochrane Database of Systematic Reviews. Reviews that included a meta-analytic component of four or more clinical trials or observational studies reporting on the efficacy of systemic or topical pharmacological treatments for adults with chronic venous disease published since 2010 were eligible for inclusion.
EVIDENCE SYNTHESIS: Eleven publications were included in this umbrella review. Change in ankle circumference was the most commonly reported outcome. Overall, several systemic treatments had significant effects compared with placebo on multiple efficacy outcomes, including measures of edema and pain. Out of them, Micronized Purified Flavonoid Fraction had the most comprehensive evidence of effectiveness on main symptoms and signs and on improving quality of life throughout chronic venous disease stages.
CONCLUSIONS: Systemic pharmacotherapies represent a valuable therapeutic option in CVD management. As a result of this umbrella review, several gaps were identified with respect to research topics that warrant further investigation, particularly in the category of topical medications.

KEY WORDS: Varicose veins; Lower extremity; Edema; Quality of life